Limjoco - Gallbladder Flashcards
What organ?
- stores bile (50 ml capacity (<1 L secreted/day)
- concentrates bile, adds mucus, emulsifies fats
- not essential for biliary function but releases bile when needed
Gallbladder
what condition?
- 95% of biliary tract disease
- may be clinically silent (~75%)
- biliary ‘colic’: excruciating constant pain
- RUQ, epigastric, radiates to shoulder/back
- follows FATTY MEAL
- stone pushed against outlet of GB –> Increases pressure –> Pain
Cholelithiasis (gallstones)
What 3 components make up Bile?
Bile = bile acids + phospholipids + cholesterol
Bile Acids
Where is Primary Bile Acids made? and what from?
Where is Secondary Bile Acids made? and what from?
- *Primary**: made in liver with cholesterol and amino acids
- -> Cholic Acid, Chenodeoxycholic Acid
- *Secondary**: made in colon from primary bile acids (Bacterial metabolites)
- ->Deoxycholate, lithocholate
These are risk factors for what condition?
FOUR F’s: Fat, Female, Forty, Fertile - multiple pregs
- Middle-aged
- Caucasian women
- Hypersecretion of cholesterol
- metabolic syndrome
- obesity
GB Cholelithiasis
What hormone is a risk factor for GB Cholelithiasis?
Oral Contraceptives, pregnancy
–>Increases expression of lipoprotein LDL receptors
–>stimulates hepatic HMG CoA reductase activity
–>enhances cholesterol uptake, synthesis
Estrogen exposure
Fact: Gallbladder Cholelithiasis Risk Factors (Cont.)
- GB Stasis (neurogenic or hormonal) –> encourages stone formation
- Hereditary Factors: ABC (ATP-binding cassette) transporters (mediate transport of BA, cholesterol, lipids) have associations with gallstone formation
What are 2 types of Gallbladder stones?
- Cholesterol Stones
- Pigment Stones
What type of stones?
- exclusively in GB
- pure
- crystalline, glistening
- radiolucent
- 75% of Native American Hopi, Pima and Navajo choleliths are these kind
Cholesterol Stones
How do GB cholesterol stones form?
Cholesterol concentration is supersaturated (exceeds solubilizing capacity of bile) and the cholesterol nucleates into solid monohydrate crystals (no longer dispersed).
If GB hypersecretes mucus it will trap nucleated crystals allowing for more aggregation of cholesterol til becomes macroscopic problem.
Cholesterol in the GB becomes soluble by aggregation with water-soluble _________ + water-insoluble __________.
bile salts + lecithins
What type of stones?
-more common in non-western countries
Causes:
-bacterial or parasitic infections
-mix of insoluble Ca+ salts of unconjugated bilirubin + inorganic Ca++ salts
(*normally only trace amts of unconjugated bilirubin in bile)
-Chronic hemolysis (increased conjugated bilirubin)
-Severe ileal dysfunction/bypass
-Bacterial infection of biliary tree
Pigment Stones
Pigment Stones
Normally, only trace amounts of unconjugated bilirubin in bile.
But with a bacterial infection, _____________ from the bacteria hydrolyze bilirubin glucuronides.
Bacteria: E. Coli, Ascaris lumbricoides (roundworm), Chlonorchis Sinensis (liver fluke)
Beta-Glucuronidases
Fact: Complications of Gallstones.
- Empyema - pus formation
- Perforation
- Gallstone ileus
- Fistula formation
- Obstructive cholestasis
- Cholangitis
- Pancreatitis
Name condition.
Mechanical disruption of the normal propulsive abiilty of the gastrointestinal tract.
Gallstone Ileus
Name Condition.
-90% caused by stone obstructing neck or cystic duct
-most important complication of gallstones
-most common reason for emergency cholecystectomy
- may occur in severly ill –> Acalculous cholecystitis (no morphological diff)
- Serosa with fibrinous exudate
- Lumen is cloudy, turbid bile, fibrin, pus, blood
Acute Cholecystitis
what is this?
-thickened, edematous, hyperemic wall
Acutely inflamed GB - Acute cholecysititis
What is this?
-pure pus
GB empyema
What is this?
Gangrenous cholecystitis with perforations
What is this?
Acute Calculous Cholecystitis
What condition?
CLINICAL: RUQ, epigastric pain > 6 hrs
Fever, nausea, tachycardia, sweating, N/V
No jaundice
IF JAUNDICE: then ____________ duct is obstructed.
Acute cholecystitis
Common bile duct
What Condition?
- may be sequel to repeat attacks of acute cholecystitis, or may develop w/o previous attacks
- 90% associated with stones
1/3 grow E. Coli
Pathology: Subserosal Fibrosis
Gray-white wall
Lumen with green-yellow, mucoid bile, usually with stones
CLINICAL: N/V, intolerance for fatty foods (not as severe as acute)
Chronic Cholecystitis
What is this?
Chronic inflammation with lymphoid follicle formation, Rokitansky-Aschoff sinuses
Complications of Acute, Chronic Cholecystitis: Name Condition
Bacterial Superinfection: ___________________
GB Perforation: ________________
GB Rupture: ________________
Biliary Enteric Fistula where bile drains into adjacent organs, air and bacteria enter biliary tree: ___________________
Worsening of preexisting medical condition: cardiac, pulmonary, renal, liver decompensation
cholangitis/sepsis
abscess
peritonitis
gallstone-induced obstruction/ileus
What is this?
Porcelain GB d/t dystrophic calcificaitons associated with increased risk for CANCER
Von Meyenberg Complexes: multiple benign hamartomas of ductal structures in hyalinized stroma; associated with PCKD, PCLD
Fact.
What condition?
- liver anomalies of the biliary tree
- presents usually late childhood, early adulthood
- chronic recurrent fever, pain, jaundice
- Cholangitis: abdominal pain, fever
Labs: Increased ESR
Elevated Biliary Enzymes
Caroli Disease
